Information U se B ehavior of Cli nicians in
- Evidence Based Medicine (EBM ) P rocess in Thailand
by
Somrux Sahapong [email protected]
Sawasdee Kha
Background
“Evidence-based medicine (EBM) ...... the conscious, explicit and judicious use of current best evidence
in making decisions about the care of individual patients”
(Sackett et al., 1996)
Background
• EBM is involved in : – The use of the best current
available evidence– Life-long learning– M edical education– Modern c linical practice
Methodology• Survey research• Closed-end questionnaires in EBM
process and information usage • 198 questionnaires were sent to Thai
clinicians using EBM process (University and Non-university hospitals)
• The data were analyzed :– Mean– Standard deviation– Percentage – Factor analysis
Results• 157 questionnaires (79.3 %) were returned• Demographic characteristics• The use of EBM process in clinical practice• The use of information in EBM process :
– Frequency– Purposes– How information obtained– Type – Resources– Tools– Strategy
• The factors affecting the use of EBM process
Demographic Characteristics
•General profile• Computer and I nternet literac
y• Online d atabase literacy
General Profile• Sex
– Male 66.2 %– Female 33.8 %
• Duration of EBM experience– MEAN 8.1 SD 5.2 (1-30) years
• Hospital– University 57.3 %– Non-university 42.7 %
Technology
University hospitals (Percentage)
- Non university hospitals (Percentage)
(n1=57)
expert
good
fair novice
notuse
expert
good
fair novice
notuse
Computer 15.6 50.0
30.0
2.2 2.2 13.4 50.7
32.8
3.1 0.0 100.0
Internet 15.6 48.9
31.1
2.2 2.2 19.4 44.8
31.3
4.5 0.0 100.0
Computer includeI nternet
17.8 50.0
27.8
2.2 2.2 14.9 46.3
32.8
6.0 0.0 100.0
Computer and I nternet Literacy
Databases
University public hospitals(Percentage)
- Non university public hospitals (Percentage)
(n1=57)
expert good
fair novice
not use
expert
good
fair novice
not use
PubMed(Clinical Queries)
20.0 47.8 25.6 3.3 3.3 12.5 46.7 28.1 3.1 9.4 100.0
UpToDate 5.7 18.2 30.7 5.7 39.8 7.8 31.3 26.0 3.1 32.8 100.0
CochraneLibrary
13.5 33.7 38.2 5.6 9.0 1.5 30.8 40.0 4.6 23.1 100.0
ACP Journ al
Club
8.0 12.5 30.7 8.0 40.9 0.0 12.5 29.7 4.7 53.1 100.0
EBM Journ al Websi
te
10.3 12.5 33.8 6.2 40.0 4.6 15.4 33.3 8.0 35.6 100.0
Online D atabase Literacy
Levels of EBM usage (score)
Percentage(n=157)
Low level of EBM usage (24-38) 5.7
Moderate level of EBM usage (39-53)
41.4
High level of EBM usage (54-68) 52.9 Total 100.0 Mean=52.7 S.D.=8.4 Min = 24.0 Max = 68.0
Level of EBM usage of Thai clinicians
The use of information in EBM process
• Frequency• Purposes• How information obtained• The types of information used in
clinical practice• Resources for information searchi
ng• Tools for information searching• Strategy in searching
Frequency of use Percentage(n=157)
Everyday 26.5 2-3 days a week 60.52-3 days a month 11.6Not use 1.4
Frequency
Purposes Percentage of use(n=157)
most moderate
seldom
least
Medical care 14.2 52.3 30.3 3.2
Continuing medical education and news medical information
39.5 50.3 10.2 0.0
Supporting their teaching and learning process
48.4 43.3 7.7 0.6
Purposes
I nformation was obtained
Percentage of use (n=157)
most moderate
seldom least
Clinicians searching by themselves
64.3 29.4 3.8 2.5
Clinicians asking for advice from (MIPs)
1.9 10.9 37.8 49.4
MIPs searching for clinicians
2.6 9.0 30.1 58.9
Colleague searching for clinicians
3.8 28.0 43.9 24.2
Nurse searching for clinicians
3.9 5.2 13.5 77.4
How information obtained
MIPs = medical informational professionals
Types of information in clinical practice
Percentage of use (n=157)
most moderate
seldom
least
Best research 33.3 57.1 9.0 0.6
Medical record 19.1 38.2 34.4 8.3
Information from clinical ex pert
14.2 47.7 34.2 3.9
Medical textbook and reference book
21.2 59.6 17.9 1.3
Medical Journal 33.3 56.4 9.0 1.3
Systematic review 32.1 51.3 14.1 2.6
Proceeding 11.5 46.2 39.1 3.2
EBM Database 18.8 52.6 24.0 4.5
The types of information used in clinical practice
Resources for informati on searching
Percentage of use (n=157)
most moderate
seldom
least
Medical record unit 7.7 34.2 46.5 11.6
Laboratory 3.9 29.9 48.7 17.5
Museum 1.4 9.15 33.8 55.6
Library inside the hospital 19.2
54.5 19.2 6.4
Library outside the hospital 5.8 23.7 41.7 28.8
Foreign library 7.9 19.5 23.7 48.9
Patient’s profile 9.9 33.1 37.1 19.9
Patient’s cousin 3.3 25.8 44.4 26.5
Expert in clinical practice 7.2 52.6 31.6 7.9Internet 33.
850.3 13.2 2.6
Resources for information searching
Tools for information searching
Percentage of use (n=157)
most moderate
seldom
least
PubMed 58.1 31.6 7.1 3.2
UpToDate 12.3 21.9 32.3 33.5
Ovid 16.8 28.4 36.0 23.9
Embase 5.2 9.7 43.9 41.3
Cochrane library 14.7 41.7 30.8 12.8
ACP Journal Club 5.2 18.7 38.7 37.4
OPAC of the library inside the hos pital or medical school
5.3 14.5 34.8 45.4
-CD Rom 3.2 25.2 38.7 32.9
Search engine 30.5 35.1 22.1 12.3
Index database 5.9 14.2 39.2 30.7
Bibliographic database 3.9 19.6 42.5 34.0
Tools for information searching
Strategy in searching
Percentage of use (n=157)
most
moderate
seldom
least
Use keyword 45.2 50.3 1.9 2.5
Consult the expert 6.5 21.9 45.8 25.8
Use similar medical term
24.8 51.0 19.7 4.5
Use medical subject heading (MeSH)
29.9 42.7 18.5 8.9
Use boolean operator (AND, OR, NOT)
35.0 41.4 15.3 8.3
Use clinical queries in PubMed
24.8 35.9 28.1 11.1
Strategy in searching
Factors affecting the use of EBM process
• Six variables were correlated with information use in EBM process– Information usage– EBM usage – Experience – Organization – Competency – Educational background
Conclusion
• Most Thai clinicians in this study use the EBM process in their daily practice.
• Thai clinicians have good c omputer / Int ernet l iteracy and online database litera
cy.• Thai clinicians can search information by
themselves.• Six variables were correlated with
information use in EBM process.
Suggestions• More studies on the knowledge, attitude and
practice of clinicians on information behaviors are needed.
• EBM training is necessary for MIPs in Thailand.
• MIPs should be trained to assist or facilitate clinicians in information searching and use.
• Collaboration between clinicians and MIPs should be much more closer.
• MIPs should make clinicians accept their compe tency in EBM information service.
MIPs = medical informational professionals
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